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Discharge criteria for SAM infants <6m who are not breastfed?

This question was posted the Prevention and treatment of severe acute malnutrition forum area and has 4 replies. You can also reply via email – be sure to leave the subject unchanged.

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Anonymous 169

Normal user

27 Mar 2010, 12:46

Hi, With a non-breastfed infant less than 6 months can anyone tell me what the discharge criteria should be? For >6m it is 15% weight gain but is this the same for <6m? According to Module 2 on IFE it is 85% of the median weight / length and has remained so for 3 days but is this still a valid measurement and what if the child is less than 45cm?
Thanks

Talal Faroug Mahgoub

Nutrition Specialist- UNICEF

Normal user

28 Mar 2010, 11:15

Infants under 6 months and/or below 4 kg with no prospect of being breastfed:

15 percent weight gain

No bilateral pitting oedema for 2 weeks

Clinically well and alert, no medical problem.

Other considerations:

At discharge, infant can be switched to infant formula.
Caregiver has been adequately counselled.

Tarig Abdulgadir

CMAM Specialist / UNICEF

Normal user

28 Mar 2010, 15:41

Hi in addition to what Talal has mentioned we should consider that for such children we need to make sure that the alternative feeding modality is safe , affordable and well understood by the caregiver, we can use the WHO recommended animal modified milk formula for feeding the child but this need spending alot of time in educating the mother aboiut how she can provide the milk , in many instances the child might stay up to 6 months if he/she is close to these age and no other solution and then we evaluate his/her situation if no complications he/she can receive plumpy nut( not before 6 monbths ) or if his situation is not fitting for OTP he/she can be moved to the stabilisation center to use F75 , these only is applied if we admit the child younger than 6 month and he/she reached 6 month and no solution is available for him or her at home, please note that for children younger than 6 months we dont have roof or limit for stay so there will be enough space for cadregiver counsilling and education

Anonymous 169

Normal user

7 Apr 2010, 15:19

Thanks Talal and Tarig for your replies.
Could I just check if this is what you do and/or is this guidance written down somewhere? It would be good to know as I believe that others are using the 85% of median weight/length and would like to look it up.
Thanks

Marie McGrath

ENN

Forum moderator

26 May 2010, 16:09

Dear Anon,
You highlight a gap in guidance (one of the many) around managing acute malnutrition in infants < 6 months.

As part of the MAMI Project completed late last year, we reviewed what guidance was used to manage this age group. Many lacked an anthropometric discharge criteria, partly because many infants of this age group were admitted under non anthropometric criteria (either for clinical reasons, poor feeding, or as you point out, length less than 45cm). Non-breastfed infant management and follow up was noted as especially lacking in key informant interviews. Rather than an 'adequate weight gain' discharge criterion as often used in breastfed infants, the guidelines reviewed reflected that non-breastfed infant was typically expected to reach the same anthropometric targets as older children prior to discharge (>80% or >85% weight-for-length). Many aspects of older child management are applied to infants <6m, but this is based on assumptions rather than strong evidence.

So the suggestion in Module 2 remains valid and in keeping with other agencies guidance, but bearing in mind that that Module 2 content was based on a peer reviewed judgement to 'stop gap' in the absence of a strong evidence base. As the MAMI project found, this weak evidence base remains and is significant.

You can download the MAMI report (Chapter 4 is the guidelines review) at:
http://www.ennonline.net/resources/741

Two notable guidance that are valuable with regard to infants<6m were:
ACF Assessment and Treatment of Malnutrition in Emergency Situations, Claudine Prudhon, 2000 (Book available for purchase via http://www.aahuk.org/publications.htm)

MSF Nutrition Guidelines (2006) http://www.msf.org.uk/books.aspx

Other key resources are listed in the appendices of the MAMI Report, http://www.ennonline.net/pool/files/ife/mami-appendices.pdf

Best regards, Marie

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